Kettering Section B- Airway care

Establishing and maintaining airways

What is the purpose of a reservoir on a manual resuscitation bag?

To provide 95-100% oxygen at 15 L/min

How to utilize a PEEP valve on a manual resuscitation bag?

Attach to the expiratory side of patient

If a manual resuscitation bag fills rapidly but collapses easily on minimal pressure what should you check?

The inlet valve (one way valve)

True or false: You can use pneumatically powered resuscitation device/ demand valves on infants

False; This is for adults only

How does you instill medications down an ETT?

Double the IV dosage (because drug has to be absorbed), flush ETT with 10 mL of saline, and hyperventilate for 30 sec

Medications you can instill down the ETT?

NAVEL;

Naloxone (narcan), atropine, vasopressin, valium/ versed, epinephrine, and lidocaine

Maintain cuff pressure at…

20-25 mmHg

25-35 cmH2O

Cuff pressure is directly related to…

capillary pressure

What medication would you recommend to paralyze a patient for intubation?

Succinylcholine

Very fast acting, wears off in a few minutes, intubation only

What is the first assessment to confirm ETT placement?

Inspection

Four ways to assess/ confirm ETT/ tube position

1. Inspection (FIRST assessment that should be done): Look for bilateral chest expansion

2. Auscultation: Bilateral breath sounds

3. Capnography/ CO2 detectors: Color should be changing to yellow/ gold

4. Chest X-ray (last, but the BEST): 2-6 cm above carina or at the aortic knob/ notch

ETT placement above the carina?

2-6 cm above carina OR at the aortic knob/ notch

What type of blade for intubation is preferred for infants?

Miller blade/ straight blade

Adult male ETT

8.0-8.5

Adult female ETT

7.0-7.5

Full-term infant ETT

3.0-3.5

Oral intubation should be about _____ cm at patient’s lips

21-25 cm

Nasal intubation should be about _____ cm at the patient’s nare

26-29 cm

When should you change an ETT

Tube is obstructed: unable to pass a sxn catheter

Tube is too small: can cause high cuff pressures ( > 25 mmHg)

Cuff is punctured: Unable to seal cuff

If cuff pressure cannot be measured what should you use

minimal leak technique

What is a CASS tube

Continuous aspiration of subglottic secretions

ETT with high-low/ subglottic suction

Used to prevent VAP

A patient arrives via EMS to the ER with a esophageal tracheal combitube (ETC). What is the first thing you should do on arrival?

Replace the ETC with a ETT

LMA cuff pressure

60 cmH2O

True or false: You can intubate with an ETT directly through an LMA

True, intubate first through LMA with ETT, then remove LMA through the ETT

During extubation, when should you remove the tube?

At peak inspiration to prevent vocal cord damage

Immediate complications of a tracheostomy (first 24 hours)

Bleeding,

pnx, air embolism, subcutaneous emphysema (air leaks)

Late complications of a tracheostomy

Infections, hemorrhage (tracheoinnominate artery fistula), obstruction, tracheoesophageal (T-E) fistula

When should a patient’s tracheostomy cuff be inflated?

When their eating, when pt is on PPV

What chemical do you use to clean a patient’s stoma?

Hydrogen peroxide

What is an extended tracheostomy tube for?

Indicated for patients who are obese or use of cervicale collars

If a patient is not tolerating a tracheal speaking device what is an alternative?

Fenestrated tracheostomy tube

What chemical do you use to clean a tracheostomy inner cannula?

Hydrogen peroxide

Adult sxn pressure

230-150 mmHg

Child sxn pressure

100-120 mmHg

Infant sxn pressure

80-100 mmHg

When would you use a coude tip catheter?

When suctioning the left main stem bronchus

Formula to determine inline catheter size

(ID size/ 2) 3

What size sxn catheter should be used for an 8.0 ETT?

12 Fr

The RT provides manual ventilation with a self-inflating resuscitation bag with the flowmeter set to flush during a resuscitation in the ICU. The RT notices that the patient valve is stuck in the open position. The RT’s initial response should be to:

Decrease the oxygen flow to the bag

Use another form of ventilation

Obtain a larger self-inflating bag

Attach a reservoir to the bag

Decrease the oxygen flow to the bag

All of the following are considered limitation of a pneumatically powered resuscitation device expect:

High risk of gastric insufflation

Inability to detect changes in patient’s lung compliance

100% oxygen is delivered directly from a 50 psi gas source

High flowrates may cause increased resistance to ventilation

100% oxygen is delivered directly from a 50 psi gas source